Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

I understand that once membranes rupture, the risk of infection
increases over time. In cases without rupture of membranes though,
can someone please explain to me what the risks are of a prolonged
first phase or second phase of labor? I must be really stupid
because I can't figure it out. Thank you! TC

Let me start by saying that it is by no means the case that
rates of infection increase with length of time after membrane
rupture if examining fingers, monitoring devices, tampons,
whatever are kept out of the vagina--or even if they are not.
(Women who test positive for GBS may be exceptions to this,
but even their babies are fine provided they get their
antibiotics onboard.) It is also possible that a brewing infection
breaches membranes and releases the fluid rather than vice versa,
especially with preterm rupture of membranes.

Returning to your question of the problem with prolonged labor
with intact membranes, it isn't that there is inherent risk in some
preset amount of time passing, but of how well the baby is
tolerating a lengthy labor and whether something is keeping the
baby from coming out no matter how much time is given or what is
tried (obstructed labor). Obstructed labor during the pushing
phase can injure the pelvic floor, leading to fistulas. This is a
big problem in developing countries where malnourished women
are married and having children too young to have fully developed
pelvises and who live in rural villages and must travel for
hours or days to get to a hospital with cesarean
capability. And, of course, where there is no timely access to
cesarean surgery, a baby who is not tolerating labor will die.

In short, how long is too long is a judgment call. Unfortunately
for women in most developed countries, it is a call usually made
well before it needs to be.

-- Henci

P.S. It troubles me that you called yourself "stupid." Besides
not being true, it isn't good for us to put these kinds of labels
on ourselves. I invite you to pay attention to occasions when you
put yourself down and to substitute more positive messages. If you
wouldn’t say it to your friend or your child, then
don’t say it to yourself.

Thanks so much for your response! And thanks for the reminder to
keep positive. I was in fact having a terrible day and was
frustrated by Williams Obstetrics which lists the dangers of long
labors to mother and baby. For baby, the danger listed is head
molding. After all the dangerous effects that induction, epidural,
and amniotomy have on baby? Are they kidding? I now believe that
the whole thing boils down to whether or not we trust a woman and
her body to take good care of her baby. The belief that the
birthing woman is an inherently dangerous place for baby to be
leads to the popularization of diagnoses such as dystocia.
Separating mother from child is crucial to promoting our societal
message that the baby in fact does not belong to mother but to
institutional safeguards of society such as the hospital. My
interest in dystocia actually originated in my attempt to
understand amniotomies. Since then I have read an excellent paper
by Leslie Dixon.
http://www.midwife.org.nz/content/documents/132/NZCOM%20Journal%20Oct03.pdf
I hope you have a wonderful day!!! Tienchin

Posted By n/a on 05/06/2007 9:17 PM
. . . I now believe that the whole thing boils down to whether or
not we trust a woman and her body to take good care of her baby.
The belief that the birthing woman is an inherently dangerous place
for baby to be leads to the popularization of diagnoses such as
dystocia. Separating mother from child is crucial to promoting our
societal message that the baby in fact does not belong to mother
but to institutional safeguards of society such as the hospital.
Tienchin

Amen, Sister! I absolutely agree. And thanks for the
article.

-- Henci

All Times America/New_York

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